Janus General Medicine

Resuscitation & Acute Critical Care

COVID Awake Repositioning /

Proning Protocol (CARP)
Aim: To avoid intubation and improve saturations in COVID19 patients
Scope: Emergency Department

Timed Position Changes

Q 2 hrs, ask patient to switch between the following positions,bed adjustments will be required
between positions

1. Left Lateral Recumbent

2. Right Lateral Recumbent
3. Sitting Upright 60-90 degrees

If patient is not CPAP Mask (because of high risk of disconnection), an additional position can
be tried:

4. Lying Prone in bed (LIP may choose to Prone CPAP patients as well)

If these 4 positions are not raising the Oxygen Saturation, a 5th position can be tried:

5. Trendelenburg (Supine, Bed 30 degrees Head Down)

15 Minutes after each position change, check to make sure that Oxygen Saturation has not
decreased. If it has, try another position.

Positions Changes to Counter Hypoxemia

If patient has a significant drop in Oxygen saturation, follow these steps:

Page 1 of 2 | Version: 1.0 | Date: 2020-04-06 | Approved SW, BW, PM The use of
this guideline is subject to professional judgement and accountability. In any individual clinical circumstance, divergence from this guideline or SOP is acceptable based on the
judgment of the clinician.

COVID CARP Protocol 2020-04-06.docx

Janus General Medicine
Resuscitation & Acute Critical Care

1. Ensure the source of the patient's Oxygen is still hooked up to the wall and is properly placed
on the patient (this is a common cause of desaturation)

2. Ask patient to move to a different position as above

3. If after 10 minutes, the patient's saturations have not improved to prior levels, speak with LIP
about escalation of oxygen modality vs. trial of additional positions

Page 2 of 2 | Version: 1.0 | Date: 2020-04-06 | Approved SW, BW, PM The use of
this guideline is subject to professional judgement and accountability. In any individual clinical circumstance, divergence from this guideline or SOP is acceptable based on the
judgment of the clinician.

COVID CARP Protocol 2020-04-06.docx